NPIMap

Organization Active NPI

Brookhaven Memorial Hospital Medical Center, Inc.

Doing business as Long Island Community Hospital

  • Health Educator
  • Patchogue, NY
National Provider Identifier
1306350715
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
License
5123000H Issued in NY
Legal business name
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.
Doing business as
Long Island Community Hospital
Practice address
103 W Main St
Patchogue, NY 11772-3003
Phone
(631) 687-4188
Fax
(631) 687-2879
NPI assigned
Nov 21, 2017
Last updated
Feb 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brenda J Farrell
Title
Vice President and Cfo
Phone
(631) 654-7175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Educator 174H00000X 5123000H NY Primary

Addresses

Primary practice location

103 W Main St
Patchogue, NY 11772-3003

Mailing address

101 Hospital Road
Diabetes Wellness Program
Patchogue, NY 11772-4870
Phone (631) 687-4188

Other names 2

  • Long Island Community Hospital Doing business as
  • National Diabetes Prevention Program Other name

National Provider Directory

National Provider Directory
Part of
Brookhaven Emer Med Ass

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1306350715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL ROAD",
            "address_2": "DIABETES WELLNESS PROGRAM",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-687-4188",
            "fax_number": "631-687-2879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W MAIN ST",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723003",
            "telephone_number": "631-687-4188",
            "fax_number": "631-687-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.",
        "enumeration_date": "2017-11-21",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "631-654-7175"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NY",
            "license": "5123000H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Long Island Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "National Diabetes Prevention Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.